Kevin J Kelleher, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101054571 Issued in VA

Practice address

12040 S Lakes Dr
Ste 207
Reston, VA 20191-1246

Phone

(703) 464-0686

Fax

(703) 464-0698

NPI assigned

Jul 26, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2025 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Generations Family Medicine PC

  • Family Medicine Physician
  • Reston, VA
  • NPI 1124239470
  NPD Authorized official
• Executive Healthcare Services PLLC

  • Family Medicine Physician
  • Reston, VA
  • NPI 1760664007
  NPD (past)
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1689674202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12040 S LAKES DR",
            "address_2": "STE 207",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201911246",
            "telephone_number": "703-464-0686",
            "fax_number": "703-464-0698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12040 S LAKES DR",
            "address_2": "STE 207",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201911246",
            "telephone_number": "703-464-0686",
            "fax_number": "703-464-0698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEHER",
        "first_name": "KEVIN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101054571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "G00463",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Navleen Kaur, M.D.
• Katherine Kavanagh, DPT
• Daniel G Kaw, M.D.
• Eskedar Kebede
• Lindsay Anne Keene, FNP-C
• Colleen Denise Kelley, PA-C
• Kelly Holman Physical Therapy
• Amanda Reeder Kelly, PT, DPT
• Erin Kelly, OTR/L
• Julia Loza Kelly, PA-C

• Family Medicine Physician in Reston, VA
• Providers in Reston, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.